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Questions about reflux and pumping to up supply

Hello... I need some advice on what to do. My baby is 10.5 weeks. Apparently she has silent reflux. I had no idea because she does not fuss or cry any more than a normal baby would. I have seen her spit up and she does so without discomfort. She almost seems relieved by it. I have also heard her silently refluxing and again it doesnt seem to bother her. I believe she had painful reflux earlier on, and a flare up last week when I consumed some dairy.
Heres the thing - at weighted feeds with my LC - she takes no more than about 2 oz at a time and then starts pulling off the nipple. She doesnt scream or fuss, she just stops eating. My LC says she is refusing to take in more because she has learned that taking in more could cause her pain. I have never counted out how many feeds we do in a day. I usually start to keep record than get caught up with taking care of baby and forget to record frequency. I feed her on demand. It could be an hour, 2, 3 or 4 hours between feeds during day. She usually eats 2-3 times overnight. Baby has been prescribed zantax but we havent given it to her b/c again, she doesnt seem bothered by the reflux as far as we can tell. My baby has plenty of wet diapers, poos almost everyday, she naps well, is alert and content while awake, and reaching milestones. She is chubby with fat rolls. Her dr was very pleased with her yesterday, commenting on how vigorous she is. So because baby takes in so little at each feed and her weight gain is slow, my LC recommends I pump 2-4 day to increase my supply. she also thinks having baby on meds will relieve reflux pain so she will eat more.

I am writing today b/c I do not want to pump. Heres why. I am just getting to the point where breastfeeding has become a lovely, special time of bonding between me and my daughter, esp during evening feedings. Why? b/c my breasts are nice and "empty". with my breasts like this, my baby actually suckles at my breast for extended periods, she drinks peacefully with lots of "kehs", she doesnt get overwhelmed by the letdown and actually falls asleep comfort nursing at my breast!!! It feels so great!!! oh, and tiny baby burps come up with ease. My experience with breastfeeding up to this point has been my baby gulping, taking in tons of air and feeding for no more than 2-3 minutes at a time , then spending lots of time trying to coax out huge, painful belches from her aching belly. overnight and early morning feedings are still often like this, though improving. My LC tells me that my babe should be able to handle my flow by now, that its not overactive letdown, it's a normal letdown. My fear is that if I pump, my breasts are going to become overly full and my baby is going to again struggle with the flow. I want her to gain weight and I do not want to lose supply due to her taking such small amounts, at the same time i do not want to pump myself into a state where baby will be overwhelmed by flow.
Here is her weight history:
9/22 - birth 6lbs
9/24 - left hospital = 5lbs 8 oz
10/ 4 - 7lbs
10/22 - 8lbs 15 oz
11/4 - 9, 13 oz
11/7 - posterior Tongue tie revision
11/13 - 10, 2 oz
11/20 - 10, 7 oz
11/22 - 10, 10 oz
11/29 - 10, 14.5 oz
12/5 - 10 13 oz
12/6- 10 15 oz

Re: Questions about reflux and pumping to up supply

Baby gained almost three pounds in the first month. Almost two the second month. Three weeks ago, 5 oz in a week. Two weeks ago, 4.5 oz in a week. That all sounds like great weight gain: http://kellymom.com/bf/normal/weight-gain/. I'm not sure what has happened this very last week - was the 11/29 weight done on the same scale as the 12/5 and 12/6 weight? With baby naked or in a dry diaper?

2 oz at a time is a perfectly normal amount for your baby to be taking in at a meal. That is why babies feed 10 or 12 times or more in 24 hours, because babies usually average between 20 and 30 oz of milk per 24 hours (24 oz is the mean), so 12 x 2 oz = 24 oz. And even if baby happened to have a few meals of 2 oz when you were with your LC, it doesn't mean that with you she isn't sometimes drinking 3 oz, or 1 oz - and that would also be normal.

Is there anything that worries YOU about your baby? It sounds like you think she is doing well. The doctor thinks she is doing well. Everything you describe sounds normal and fine, and it sounds like you have gotten into a great nursing rhythm with your baby. I agree with you, it sounds like pumping is not only unnecessary but could easily cause problems - as you are rightly aware. If your LC's recommendations don't feel right, or if you are concerned about the apparent lack of weight gain between 11/20 and 12/5, you could consider a second opinion from a different LC...

Re: Questions about reflux and pumping to up supply

Hmmm. I agree with bfwmomof3, but I am noticing that weight gain apparently slowed quite a bit AFTER the tongue tie revision, which does seems odd. Yet weight gain overall seems normal. So I am a bit flummoxed. I wonder if the unusually high weight check frequency is making it appear there is a gain problem when there is not.

I do have one important question as regards pumping- Are you using nipple shields when nursing? Also, is there any reason to be concerned about your milk production for some other reason-such as, are you on birth control or other meds that might affect milk production? Sleep training? Lots of pacifier use?

Assuming there is a gain problem at all, if the problem is baby will not take in more than 2 ounces at a time, can you explain why your LC thinks you need to up your milk production let alone, why you have to pump to do it? If baby only wants 2 ounces at a time, I am not sure what upping your milk production is going to do to solve that. Why not simply nurse baby more often? (or offer, baby may refuse, which would indicate baby is getting enough milk.) Frequent nursing is good for reflux, good for forceful letdown, good for production, and good for more milk into baby. Assuming breastfeeding is comfortable for mom, there is no downside to frequent nursing that I am aware of.
If you go to www.askdrsears.com and look up GERD, that is a good article on reflux imo.

Re: Questions about reflux and pumping to up supply

Originally Posted by @llli*bfwmomof3

Baby gained almost three pounds in the first month. Almost two the second month. Three weeks ago, 5 oz in a week. Two weeks ago, 4.5 oz in a week. That all sounds like great weight gain: http://kellymom.com/bf/normal/weight-gain/. I'm not sure what has happened this very last week - was the 11/29 weight done on the same scale as the 12/5 and 12/6 weight? With baby naked or in a dry diaper?

2 oz at a time is a perfectly normal amount for your baby to be taking in at a meal. That is why babies feed 10 or 12 times or more in 24 hours, because babies usually average between 20 and 30 oz of milk per 24 hours (24 oz is the mean), so 12 x 2 oz = 24 oz. And even if baby happened to have a few meals of 2 oz when you were with your LC, it doesn't mean that with you she isn't sometimes drinking 3 oz, or 1 oz - and that would also be normal.

Is there anything that worries YOU about your baby? It sounds like you think she is doing well. The doctor thinks she is doing well. Everything you describe sounds normal and fine, and it sounds like you have gotten into a great nursing rhythm with your baby. I agree with you, it sounds like pumping is not only unnecessary but could easily cause problems - as you are rightly aware. If your LC's recommendations don't feel right, or if you are concerned about the apparent lack of weight gain between 11/20 and 12/5, you could consider a second opinion from a different LC...

Originally Posted by @llli*bfwmomof3

Baby gained almost three pounds in the first month. Almost two the second month. Three weeks ago, 5 oz in a week. Two weeks ago, 4.5 oz in a week. That all sounds like great weight gain: http://kellymom.com/bf/normal/weight-gain/. I'm not sure what has happened this very last week - was the 11/29 weight done on the same scale as the 12/5 and 12/6 weight? With baby naked or in a dry diaper?

2 oz at a time is a perfectly normal amount for your baby to be taking in at a meal. That is why babies feed 10 or 12 times or more in 24 hours, because babies usually average between 20 and 30 oz of milk per 24 hours (24 oz is the mean), so 12 x 2 oz = 24 oz. And even if baby happened to have a few meals of 2 oz when you were with your LC, it doesn't mean that with you she isn't sometimes drinking 3 oz, or 1 oz - and that would also be normal.

Is there anything that worries YOU about your baby? It sounds like you think she is doing well. The doctor thinks she is doing well. Everything you describe sounds normal and fine, and it sounds like you have gotten into a great nursing rhythm with your baby. I agree with you, it sounds like pumping is not only unnecessary but could easily cause problems - as you are rightly aware. If your LC's recommendations don't feel right, or if you are concerned about the apparent lack of weight gain between 11/20 and 12/5, you could consider a second opinion from a different LC...

Thank you SO much for your response. this makes me feel much better.

I agree that when you look at the big picture, her weight gain is great. She looks on target to double her weight by 4 months. To answer your question, those weights were taken on different scales with baby in a dry diaper. Hopefully I'll see weight gain by next week, if not and my supply is indeed compromised, I should still have time to bring it back, no?.

It also makes sense that 2oz is a normal amount to take. Is not the baby's tummy the size of her fist? I always wondered how can 3-5 oz fit in that, esp if mom's flow is fast.

When I look at my baby, I just can't imagine that she is starving herself b/c of reflux. I could understand if she was one of those babies that screams for hours due to the pain of refluxing. She comes off the boob smiling and content, yes it's only 2 oz but it seems like that's all she wants until the next feeding. The only issue baby has is overnight, she seems to squirm and perhaps writhe and arch and let out lots of gas. She seems uncomfortable but doesnt cry. If you turn on the light and wake her up, she seems fine. Is that normal? Now, I have read some stories on the web of reflux babies who basically took enough breastmilk to survive, but not grow which led to mom's supply getting low. I can only hope that is not happening to me!

I have tried to feed her today every 1-2.5 hours. She certainly nurses for a very short time, 5 min or less. I hope she is getting enough.

Re: Questions about reflux and pumping to up supply

The different scales could explain why it looks like baby didn't gain that week - if they're off each other by even a quarter of a pound, then any gains that week could be erased! I'm really doubting that your supply is compromised in any way - but even if it is slightly less this week for whatever reason, given that you are full-time nursing, there's no reason to think that it can't be buffed up by additional nursing (and pumping if need be) next week.

Yes, baby's tummy is tiny!

When you feed baby overnight, what position is she nursing in? I'm wondering whether she is lying down and whether that is making her uncomfortable, if, for example, she is in a more upright position during the day? Or after you turn the lights on at night? You could try holding her in a more upright position for a period of time after her feeding, and see if that helps. It makes the nighttime feeding longer and more tiring, but if the alternative is watching her squirm and writhe I imagine you are not falling asleep during that time anyway.

Babies get more efficient as they get older, and particularly if there is fast flow, they can easily drink their fill in just a few minutes. Length of feeding is not a reliable sign of how much they are getting.

Re: Questions about reflux and pumping to up supply

Originally Posted by @llli*lllmeg

Hmmm. I agree with bfwmomof3, but I am noticing that weight gain apparently slowed quite a bit AFTER the tongue tie revision, which does seems odd. Yet weight gain overall seems normal. So I am a bit flummoxed. I wonder if the unusually high weight check frequency is making it appear there is a gain problem when there is not.

I do have one important question as regards pumping- Are you using nipple shields when nursing? Also, is there any reason to be concerned about your milk production for some other reason-such as, are you on birth control or other meds that might affect milk production? Sleep training? Lots of pacifier use?

Assuming there is a gain problem at all, if the problem is baby will not take in more than 2 ounces at a time, can you explain why your LC thinks you need to up your milk production let alone, why you have to pump to do it? If baby only wants 2 ounces at a time, I am not sure what upping your milk production is going to do to solve that. Why not simply nurse baby more often? (or offer, baby may refuse, which would indicate baby is getting enough milk.) Frequent nursing is good for reflux, good for forceful letdown, good for production, and good for more milk into baby. Assuming breastfeeding is comfortable for mom, there is no downside to frequent nursing that I am aware of.
If you go to www.askdrsears.com and look up GERD, that is a good article on reflux imo.

Originally Posted by @llli*lllmeg

Hmmm. I agree with bfwmomof3, but I am noticing that weight gain apparently slowed quite a bit AFTER the tongue tie revision, which does seems odd. Yet weight gain overall seems normal. So I am a bit flummoxed. I wonder if the unusually high weight check frequency is making it appear there is a gain problem when there is not.

I do have one important question as regards pumping- Are you using nipple shields when nursing? Also, is there any reason to be concerned about your milk production for some other reason-such as, are you on birth control or other meds that might affect milk production? Sleep training? Lots of pacifier use?

Assuming there is a gain problem at all, if the problem is baby will not take in more than 2 ounces at a time, can you explain why your LC thinks you need to up your milk production let alone, why you have to pump to do it? If baby only wants 2 ounces at a time, I am not sure what upping your milk production is going to do to solve that. Why not simply nurse baby more often? (or offer, baby may refuse, which would indicate baby is getting enough milk.) Frequent nursing is good for reflux, good for forceful letdown, good for production, and good for more milk into baby. Assuming breastfeeding is comfortable for mom, there is no downside to frequent nursing that I am aware of.
If you go to www.askdrsears.com and look up GERD, that is a good article on reflux imo.

Thanks so much! Not certain why weight gain has slowed after tt revision. it was a very tough 2 weeks after the procedure was done. i wonder if the stress of it made her silent reflux flare? i also noticed my supply started to regulate around that time.

I do not use nipple shields. Not on birth control or any other meds. No sleep training. Not even sure what that is. She sleeps well overnight, and has done so since 4 weeks with no training by me. She wakes throughout the night to feed, and falls back to sleep easily. She does not accept a pacifier. She did occasionally before tt revision, but will not now. we have been trying to get her to accept a bottle of expressed milk since 5 weeks but to no avail.

I think my LC wants me to pump to get supply up b/c she thinks the baby's demand has my supply at a low level. She believes that baby is limiting nursing due to pain from reflux. Again, I have a hard time believing that since baby does not mind being on her back, doesnt cry when she spits up, does not cry at the breast, or really much at all in general. She does pop on and off at 95% of feeds. I guess that's a sign of reflux, but I believe there are many other things that could be causing her to pop on and off. When I mentioned that she doesnt seem to be in pain from reflux, she said the milk is coming up and burning her throat when she has more than 2 oz at a time so she learned to limit herself to that much. She said she sees this happening all the time and moms with reflux babies are shocked when they go to the 4 month appt and find baby has not gained any weight.

My supply does feel a bit low compared to what Im used to, but then again Im not sure what regular is supposed to feel like. I fed her this morning then pumped at got 2oz out of each breast in 5 minutes. is that any indication? Will a 10 week old baby who is not getting enough milk be able to poop almost everyday?

I agree: frequent nursing is way to go! I can do it as long as my breasts are not overly full... as you know, too much milk hitting tummy quickly aggravates reflux. thanks!!

Re: Questions about reflux and pumping to up supply

She said she sees this happening all the time and moms with reflux babies are shocked when they go to the 4 month appt and find baby has not gained any weight.

Ok. But this does not mean your baby has reflux. Does it? Your baby had tongue tie-but she is sure latch and sucking pattern is all ok now? Your baby is gaining weight. And if the problem is pain from reflux, wouldn't that be solved with the medication baby has been prescribed? I really don’t want to go against your IBCLCs advice. She is there watching baby nurse and I am not. Maybe she is seeing something you are not. But it sounds to me like you have questions and need more clarification from her.

I fed her this morning then pumped at got 2oz out of each breast in 5 minutes. is that any indication?

well, yes. Sort of. Assuming your baby took 2 ounces when baby nursed, it indicates there was 4 ounces more available at the moment. While poor pump output does not necessarily mean low production, this high an output would indicate good production-and I suppose it could mean your baby did not want much milk at all and left your breasts full. This is another reason why it really does not work to measure production or intake one way or the other with pump output. And since I don't know how long it had been since baby last nursed, and its just one pump session, I hesitate to say it means anything conclusive. But certainly no matter how you slice it, being able to pump 4 ounces at a sitting is not indicative of low production.
Kellymom has an excellent article on low production - in particular, read the section on how to tell if supply is actually low. http://kellymom.com/bf/got-milk/supp...es/low-supply/

I agree: frequent nursing is way to go! I can do it as long as my breasts are not overly full... as you know, too much milk hitting tummy quickly aggravates reflux. thanks!!

if you are nursing frequently, that prevents breasts from getting overly full. Over fullness is caused by not nursing with enough frequency (and/or poor latch and/or overproduction.)

Re: Questions about reflux and pumping to up supply

Originally Posted by @llli*bfwmomof3

The different scales could explain why it looks like baby didn't gain that week - if they're off each other by even a quarter of a pound, then any gains that week could be erased! I'm really doubting that your supply is compromised in any way - but even if it is slightly less this week for whatever reason, given that you are full-time nursing, there's no reason to think that it can't be buffed up by additional nursing (and pumping if need be) next week.

Yes, baby's tummy is tiny!

When you feed baby overnight, what position is she nursing in? I'm wondering whether she is lying down and whether that is making her uncomfortable, if, for example, she is in a more upright position during the day? Or after you turn the lights on at night? You could try holding her in a more upright position for a period of time after her feeding, and see if that helps. It makes the nighttime feeding longer and more tiring, but if the alternative is watching her squirm and writhe I imagine you are not falling asleep during that time anyway.

Babies get more efficient as they get older, and particularly if there is fast flow, they can easily drink their fill in just a few minutes. Length of feeding is not a reliable sign of how much they are getting.

Overnight, I feed her in an upright position, sort of seated in my lap. That is my go to position, around the clock. I always keep her in an upright position after eating overnight. She sleeps part of the night in a rock n play in which her head is elevated
and part of the night in my arms. The thing is sometimes I feed her during the day and I can put her on her back to change her diaper or allow her to kick and she is just fine. She might spit up just a little sometimes but it does not both her. babies spit up! the problem is when it causes them pain, right? this is why I have a hard time buying into the "she has reflux thats why she is only taking 2oz" perspective. I am thinking the squirming and writhing is due to gas and working on a BM, but I could be wrong.

My baby has always fed for less than 5 min. I kept going to the doctor and LC saying this girl doesnt stay on my breast for long - Im worried. The first LC is saw diagnosed the tongue tie and said she was concerned my oversupply was getting her by. She asked me how her suck felt, did it feel like a vacuum? like when I was on the pump? I said no not really, but the milk is flowing out so easily for her, why would she need to suck vigorously. And how did she bring in my milk so abundantly if she cant suck? So we got the TT revision, but I dont notice a difference in how the suck feels. I have no nipple damage, nursing does not hurt. She is able to motivate my letdowns just fine. I do see her sticking out her tongue further and cupping it. Is it possible its not reflux but perhaps she's only taking 2 oz and not gaining well because my supply has regulated and she's an inefficient nurser?

I have noticed a definite dip in my supply over the weekend. I have also noticed baby pulls off less now. She actually stays on for the letdown. But since there is less milk in my breasts, i wonder if she's getting enough?

Re: Questions about reflux and pumping to up supply

. She might spit up just a little sometimes but it does not both her. babies spit up! the problem is when it causes them pain, right? this is why I have a hard time buying into the "she has reflux thats why she is only taking 2oz" perspective

Spit-up is normal. It's only a problem when it happens in concert with pain and/or poor weight gain.

And of course 2 oz is normal intake. This is why breastfed babies feed so often- the average intake is small, generally 2-4 oz. Intake will vary by baby and by feeding. But as long as a baby feeds pretty frequently, those 2 oz servings will add up to perfectly normal intake.

Did the IBCLC do just 1 weigh-feed-weigh session? If so, that's not enough. You need multiple weigh-ins to get a sense of the baby's average intake. I personally found that 1-2 days' worth of data was necessary.

My baby has always fed for less than 5 min

Totally normal when mom has oversupply.

I kept going to the doctor and LC saying this girl doesnt stay on my breast for long - Im worried.

The default for most medical professionals is to respond to concerns by doing something. Perhaps in this situation, they responded to repeat concern from you by suggesting a greater level of intervention than was necessary?

The first LC is saw diagnosed the tongue tie and said she was concerned my oversupply was getting her by. She asked me how her suck felt, did it feel like a vacuum? like when I was on the pump?

Okay, now I think we've arrived in crazy town. I have both pumped and nursed, and my kids' latches never felt like vacuums or like the pump. Both babies were able to get sufficient milk with a much more gentle action than that delivered by my pump. When they were latched on well, it felt like no more than a gentle tugging. There was no sensation of suction.

Is it possible its not reflux but perhaps she's only taking 2 oz and not gaining well because my supply has regulated and she's an inefficient nurser?

This seems unlikely.

If she was an inefficient nurser, then her intake would probably have dropped below 2 oz when your supply regulated. The fact that she too 2 oz when there was oversupply in the mix and takes 2 oz now suggests that she wants 2 oz. Though unless you have more data, I don't know that you can know how much she takes at a feeding.

I have noticed a definite dip in my supply over the weekend. I have also noticed baby pulls off less now. She actually stays on for the letdown. But since there is less milk in my breasts, i wonder if she's getting enough?

Watch her diaper output. If that continues to be sufficient, she is probably getting enough.

Re: Questions about reflux and pumping to up supply

I posed this question on a reflux support group forum:

Does anyone have a reflux baby who seems happy and content, but refuses to eat more than a little at a time?

here are the responses:

"Yes, that is exactly my DS. I tried to believe the DR that he didn't have reflux, and cut his Zantac dose after his 2 month check up. At that appt he was 58% for weight. By his 4 month, he had dropped to 18th%. We spent the next 2 months looking for answers and getting it under control. now at 6 months, it is getting better, but he has dropped to the 7th percentile. My supply has taken a hit, so I now pump and bottle feed so we know how much he is getting and that its enough. I'm having to use Go Lacta to try to boost my milk production."

"Yes the peds didn't listen to me for months and actually took my little guy off his axid dose because of good weight gain and he's simply a "happy spitter" but his spitting wasnt the issue... I could see him swallow and gulp then eventually went from 5-6 oz down to 2 and totally refused to nurse! It's so hard! Finally after calling 100 times it seems they referred him to a GI where he got a PPI and now drinks wonderfully and even nurses some! The ladies on here have bed. A great help and encouragement! I followed ^^ stormy story and that's how I knew my little guy wasn't just being stubborn!"

"oh yea..that's how i know the reflux is bothering him. I woud look into a PPI such as prevacid, prilosec or nexium to help. refusals is a clear sign of pain for a little one."

my goodness, how did babies survive before the introduction of zantac and prevacid???? I just cant believe this!!!